RN Quality Assurance Job at Medi Nurse Home Care
Medi-Nurse Home Care is one of the fastest growing Home Care Agency in South Florida. We offer Skilled Nursing, Physical Therapy, Occupational Therapy, Medical Social Workers, and Speech Therapy care to individuals in the comfort of their homes.
Medi-Nurse mission is to foster a collaborative team of passionate professionals who provide quality and superior healthcare to each heartbeat that we are entrusted with.
We are hiring a Clinical Resources Manager for our Office who performs medical record reviews to determine the quality of care; identifies quality issues and assures compliance with medical record standards and regulatory mandates.
Responsibilities
- Review all Medicare episodic clinical records at the local level to assure appropriate documentation for reimbursement.
- Oversee the maintenance of clinical records and files to comply with Conditions of Participation (COPs), using measurements, as licensure, certification, and accreditation results.
- Audit charts for clinical oversight and compliance and adherence to the Medicare guidelines
- Review OASIS and formulating 485’s.
- Manage clinical activities, including patient assessments, care plan development, service level determination, on-site field visits, and the implementation/coordination/maintenance/evaluation of care plans.
- Be involved with the supervision of clinical staff.
- Participate in the recruitment, interviewing, selection, and orientation of team members; evaluate their performance relative to job goals/requirements; coach staff and recommends in-service education programs and ensure adherence to internal policies/standards.
- Manage the assignment of clinical associates.
- Ensure service quality and participates in care coordination to ensure proper communication between caregivers, patients, referral sources and payers.
- Discuss operational issues, update staff on new/changed regulations and review records/documentation to ensure regulatory and in-house compliance.
- Have oversight of clinical integrity of appropriate documentation, quality of care provided, visits utilization, appropriate contacts with physicians, adherence to the care plan, and evidence of communication between disciplines.
- Be accountable for financial responsibility related to budget goals through utilization, documentation, providing appropriate and accurate patient care, case mix weight, and appropriate utilization of delivery of patient care.
- Conduct and/or delegate the assessment and reassessment of patients, including updating of care plans and interpreting patient needs, while adhering to Company, physician, and/or health facility procedures/policies
- Coordinate communication between team members/attending physicians/caregivers to ensure the appropriateness of care and outcome planning and ensures compliance through review of documentation and care coordination activities
- Participate in performance improvement activities, maintain ongoing clinical knowledge through internal/external training programs, and provide interpretation of knowledge and direction to staff
- Identify clinical problem areas and documents deficiency trends in a proactive approach
- Educate administrative and clinical associate staff in the correction of these deficiencies
- Assist with quality improvement and Medicare compliance training program
- Review OASIS documents for accuracy and completeness prior to locking and submitting data electronically
- Explain and mentor clinicians and staff on COP’s and on billable skilled visits
- Educate and mentor clinicians one on one (in person or over the phone) regarding concerns, questions, accuracy of OASIS data, and other related documents, that are being reviewed
- Facilitate the ICD 10 coding of the Plan of Treatment based on OASIS data and patient assessment documentation that is assessed by the Field RN while in the patient home
- Participate in the Office On-Call rotation.
- Assist Intake with referral approval and coverage if needed.
Qualifications
- Active Registered Nurse License
- Minimum of two years clinical home care experience
- Minimum of two years clinical Medicare Home Health Experience
- Minimum of one year in a clinical management role
- Knowledge of state and federal home health agency regulations/Conditions of Participation and compliance standards and regulations
- Must possess the ability to lead and manage clinicians and office staff for successful patient outcomes and clinical and branch performance.
- Proven track record of clinical management, education, and management of healthcare staff
- Outstanding leadership and managerial skills
- Knowledge of clinical policies and procedures and ability to implement.
- OASIS certified (preferred)
Full-Time We offer:
Annual Salary $70,000 - $75,000
Annual Salary $70,000 - $75,000
$30 Monthly cell phone allowance
Work/Life Balance
PTO/Holiday pay
Medical/Dental/Vision & Supplemental Life Benefits
Career Advancement
Continuing Education Units
Perks at Work
Work/Life Balance
PTO/Holiday pay
Medical/Dental/Vision & Supplemental Life Benefits
Career Advancement
Continuing Education Units
Perks at Work
We would like for you to join our family and help you build a long and rewarding career with our organization.
Please Note :
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